Insulin resistance - stress and FODMAP

Status
Not open for further replies.
O

oscareo

Member
Relationship to Diabetes
Type 1
33 year old male Type 1 diabetic for 25 years. Insulin pump

For the past 3 years I have been getting large levels of blood sugar spikes that seem to be worryingly unresponsive to insulin.
I was also getting gastroinstestinal symptoms (dry mouth, lips and bloating) and it seems to be related to eating high FODMAP foods, so I have cut them out of my diet completely. This has helped a large amount, but I still feel very pinned down in my diet now.

In addition, I find that the same thing happens in response to stress. After a stressful event or day, my blood sugar creeps up, and despite large amounts of correction dosage, it seems to have no effect. Eventually, once the stress subsides after several hours, the blood sugars return to normal. Because of this, I now feel very pinned down in my daily activity, and have eliminated things such as heavy weights, cardio and long days out.

Has anyone had a similar experience to this, or offer any advice?
Thank you
 
What does your specialist/team say?

What insulin(s) are you on?
 
Hi @oscareo

It sounds as if diabetes is controlling your life.

Rising blood sugars are not unusual in stressful situations - it is our "helpful" liver dumping glucose to give us some energy. You mention that you have an insulin pump, I find I can manage my liver if I do a temporary basal increase whilst I am in stressful meetings or when doing resistance exercise (such as climbing).

However, when I failed to stop the rise, like you, I find I reach a point of insulin resistance - above 15,,ol/l I can need twice as much bolus to correct and it can appear to take an hour to take effect. I find increasing my basal during that first hour can help.

I wonder if you have built up some lumps around your pump sites which can also cause insulin resistance. This is definitely possible after 25 of injecting and pumping. Do you change your sites regularly?

@ColinUK asked what insulin(s) you are using. I guess as you have a pump, you are only using one fast acting insulin. Changing to one of the ultra fast insulins, FIASP, helped me reduce my pre-bolus times. Unfortunately, the sped at which it works seems to be very dependent upon my starting levels - at 4mmol/l it works instantly, above 10mmol/l it take 30 to 60 minutes. This usually motivates me to keep a closer eye on my levels and correct when I see it creeping up which is so much easier on a pump. But I am not perfect ... especially if some stress creeps up on me.

I hope I have provided a few useful suggestions and you can start showing your diabetes who's boss so you can get back to living your life as 33 year old should.
 
Hi @oscareo How long have you had a pump, and where do you put your cannulas? I started having persistent highs after a few years on a pump, and changing to a new body area made a difference. I didn’t have any lumps, but there were areas of thicker skin with poor absorption.

And when did you last have a coeliac screen? Gut issues can cause erratic sugars sometimes.
 
Inka said:
Hi @oscareo How long have you had a pump, and where do you put your cannulas? I started having persistent highs after a few years on a pump, and changing to a new body area made a difference. I didn’t have any lumps, but there were areas of thicker skin with poor absorption.

And when did you last have a coeliac screen? Gut issues can cause erratic sugars sometimes.
Click to expand...
Hello @Inka

Thanks for your message. I've been on a pump for 7 years, and had this current one for 3 months. I change cannula regularly and there are no signs of swelling or buildup. I have also tested negative for coeliac disease.

Oscareo
 
oscareo said:
Hello @Inka

Thanks for your message. I've been on a pump for 7 years, and had this current one for 3 months. I change cannula regularly and there are no signs of swelling or buildup. I have also tested negative for coeliac disease.

Oscareo
Click to expand...

Ok, well it was approx 4 and 1/2 years after I started pumping that I began to have issues. It’s not to do with changing your cannula regularly, it’s a problem that builds up gradually. The affected areas have no swelling and the changes are extremely subtle. When I realised what was causing my highs, it took me a while to actually believe it.

Do you use only your tummy for cannula sites?
 
Hi @Inka

Thanks again for your input. I am aware of the effect you are talking of, it is called lipohypertrophy, however I do not feel that this would be the underlying issue involved here. But it will definitely be something I will keep a keen eye on!

Thank you
 
No, it’s not that. My consultant checked. It was/is a reaction to the cannulas dripping in insulin. However, there are no fat deposits or lumps. I specifically had the area checked by my DSN and my consultant. It was not caused by not rotating sites or not changing cannulas. It’s something my consultant says they sometimes see with pumps due to the drip-drip of tiny amounts of insulin over 2/3 days and the presence of the cannula.

You mention spikes - are they random or post-prandial? My final thought - could your digestion be ‘off’ in some way, making it more difficult for you to time your insulin to cover your food?
 
Interesting thanks for you thoughts.

I have recently had an insulin pump change, and the peaks seem to be more spiky rather than a gradual rise, so I am quite certain it is not the cannula or pump.

My spikes are post-prandial, but at the same time, sometimes there are no spikes and it drops very quickly instead. Back in 2019 when I first had these issues, I had been prescribed metoclopramide, and whilst I was on this I would have no spikes at all, but a relentless number of hypos. That medication works to speed up digestion, so I would guess there is some gut related disorder. I have also had h pylori test, and a barium meal scan, which all came back normal. I have just put it down to IBS and stress related disorder.
 
Status
Not open for further replies.
Back
Top